Provider Demographics
NPI:1942464664
Name:GILL, PAMELA (PT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:PERSIS
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11143 EAST RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-2146
Mailing Address - Country:US
Mailing Address - Phone:708-974-0058
Mailing Address - Fax:
Practice Address - Street 1:9050 W 81ST ST
Practice Address - Street 2:
Practice Address - City:JUSTICE
Practice Address - State:IL
Practice Address - Zip Code:60458-1350
Practice Address - Country:US
Practice Address - Phone:708-496-7744
Practice Address - Fax:708-496-3382
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070002834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist